Provider Demographics
NPI:1437124260
Name:SHARPNACK AND MASKARINEC MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:SHARPNACK AND MASKARINEC MEDICAL GROUP, PC
Other - Org Name:HICKORY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRAKOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-356-2273
Mailing Address - Street 1:4151 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:PA
Mailing Address - Zip Code:15340-1439
Mailing Address - Country:US
Mailing Address - Phone:724-356-2273
Mailing Address - Fax:724-356-2585
Practice Address - Street 1:4151 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:PA
Practice Address - Zip Code:15340-1439
Practice Address - Country:US
Practice Address - Phone:724-356-2273
Practice Address - Fax:724-356-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098338Medicare PIN